The Role of Religion and Spirituality in Conceptualizing Reproductive Loss in Gestational Surrogacy

Mary Riddle, Ph.D., Assistant Teaching Professor, Department of Psychology, The Pennsylvania State University

Background and Introduction: Reproductive losses, which are often not visible, are not medically uncommon and may therefore be minimized or unacknowledged by medical professionals (Jaffe, 2014). Gestational surrogates, who have no genetic connection to the babies they carry for others, may also experience reproductive losses associated with their surrogacy pregnancies. These losses may be even more unacknowledged by the medical community, perhaps because a surrogate is carrying “someone else’s” baby. Understanding how gestational surrogates conceptualize and cope with loss associated with their gestational pregnancies is critical for their psychological well-being and should be a priority for health professionals who work with this population.

Materials and methods: Limited research has been conducted on the experience of surrogacy. In-depth, semi-structured interviews were audio-taped and transcribed verbatim. Grounded theory analysis of data included line-by-line coding and emergent themes were identified.

Results: 17 gestational surrogates had a total of 28 pregnancies (36 surrogate children). Reproductive losses included adverse events experienced within the process of gestational surrogacy. Among this study sample (n = 17), these included 14 failed embryo transfers, 4 miscarriages, and 2 emergency hysterectomies that were the result of surrogacy birth complications. Additionally, 10 matches with intended parents fell through, often because the intended parents did not want to continue working with a gestational surrogate after a failed embryo transfer. There were 3 instances where the intended parents cut ties with the gestational surrogate after the birth of the child(ren), leaving those gestational surrogates having no further contact with the families they had helped to create.

Themes emerging from the narrative data included feeling that gestational surrogacy was a religious or spiritual “calling”; that the experience of gestational surrogacy was rooted in altruism; that gestational surrogacy provided existential meaning and purpose to life; and that religious/spiritual beliefs/faith play a significant role in conceptualizing and coping with loss.

Conclusions: Reproductive losses often go unacknowledged, leaving women who experience them to grieve alone and in silence. These types of losses leave women at higher risk for negative psychological outcomes such as depression and anxiety. Reproductive losses experienced by gestational surrogates, who do not share a genetic connection to the child they are carrying, are even less acknowledged and may not be treated as compassionately as women who lose their “own” pregnancy. It has been reported that religious and spiritual themes are often present in the narratives of gestational surrogates (Fisher, 2013). This study shows that gestational surrogates may express their experiences of loss using religious/spiritual language. Previous research has shown that is important to explore the meaning of any reproductive loss within the context of each individual woman’s life and experiences (Covington, 2006). Therefore, understanding and utilizing the religious/spiritual beliefs of a gestational surrogate may be one way for health professionals to help them process and grieve losses associated with their surrogacy experience. These women may be particularly vulnerable during the time following a loss and their psychological well-being should be a primary consideration for those who work with this unique population.